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Clínica de acupuntura y hierbas de Cai

Nuestra clínica le da la bienvenida en la enfermedad y en la salud.

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Cai's Clinic of Acupuncture and Herbs Consent Form

If you agree with both Pages on the right, Please fill out the below form.

First Name

Last Name

Health Care Provider-Patient Arbitration Agreement. Choosing "YES" means that you Agree and Sign Aritcle 1, Article 2, Article 3, Article 4, Article 5, Article 6 from the form on the right side of this page. *

No

Yes

Division of Clinics Informed Consent to Acupuncture/ Oriental Medicine Treatment. Choosing "YES" means that you Agree and Sign with the form on the right side of this page (second form). *

No

Yes

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Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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Tel: 1-760-338-8213

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